Veronica Rouse
Charlotte
Summary
Detail-oriented claims processor with a focus on accuracy and compliance in claims management. Experienced in training team members and resolving issues proactively to enhance operational efficiency and customer satisfaction.
Overview
14
14
years of professional experience
Work History
Claims Processor
NTT Data
Charlotte
05.2025 - Current
- Processed a high volume of incoming claims in accordance with established policies and procedures.
- Reviewed and processed claims for accuracy and compliance with policies.
- Verified claim data correctness in preparation for processing.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
- Reviewed and verified insurance policy information to assess coverage and determine appropriate claims processing procedures.
- Coordinated benefits with medical insurance plans and Medicare providers.
- Provided training and support to new team members on claims procedures.
Quality Assurance Analyst
CareMetx
Charlotte
10.2025 - 03.2026
- Conducted internal audits to measure adherence to established QA standards.
- Participated in requirements review meetings to ensure clarity and completeness.
- Collaborated with cross-functional teams to identify and resolve issues.
- Reported issues in a timely manner with accurate descriptions and steps to reproduce them.
- Communicated regularly with management to discuss quality trends.
Community Associate
Regus/Robert Half
Rock Hill
03.2024 - 07.2025
- Planned and executed community events for clients to enhance resident engagement.
- Coordinated communication between management and maintenance teams to streamline issue resolution.
- Supervised common areas, ensuring proper usage by residents and their guests.
- Treated visitors with friendly, approachable attitude.
- Directed numerous calls per day to appropriate recipients using multi-line system.
- Sorted and distributed incoming mail while coordinating pickups for outgoing parcels to ensure timely delivery.
- Delivered mail to designated departments within the organization. to appropriate recipients within organization.
- Operated postage meters and other mailing equipment to process bulk mailings.
- Assisted in managing office supply inventory to ensure availability..
Operations Specialist
Republic Finance
Charlotte
06.2022 - 10.2023
- Oversaw daily operations to maintain efficiency and ensure smooth workflow.
- Optimized human resources, supplies and equipment through proactive project management.
- Guided team through process planning, including estimating personnel, materials and facility needs.
- Facilitated collaboration by coordinating communication between departments.
- Resolved customer complaints promptly through effective problem-solving skills.
- Processed new paperwork, recorded information and validated data against standards.
Database Analyst
Amerigas
Charlotte
10.2019 - 03.2022
- Resolved billing disputes and negotiated payment plans with delinquent customers to recover outstanding debts.
- Posted payments, reconciled invoices, and created accurate billing statements to ensure timely financial reporting.
- Negotiated renewal contracts with clients within budgeted range.
- Negotiated sales contracts, terms of service agreements.
- Collaborated with peers and staff to foster a supportive and cooperative work atmosphere.
Reimbursement Counselor/Claims Analyst
Lash Group
Charlotte
05.2015 - 04.2019
- Collects and reviews all patient insurance benefit information, to the degree authorized by the standard operating procedure of the specific program.
- Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications.
- Processes any necessary insurance/patient correspondence.
- Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
- Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers.
- Researches and resolves any claim denials or underpayment of claims.
- Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors.
- Researches and resolves any electronic claim denials.
- Verifies patient eligibility and benefits.
- Provides timely follow up on unpaid, denied, and/or short paid claims.
- Followed up on unpaid, incomplete and rejected claims.
Provider File Specialist 1
Blue Cross Blue Shield
Florence
05.2013 - 04.2015
- Responsible for establishing and maintaining certification of health care providers.
- Support of provider directories.
- Accurate/timely claims adjudication and provider billing.
- Research and resolve problems.
- Make outbound calls to providers.
Claims Processor 1
Blue Cross Blue Shield
Florence
01.2013 - 05.2013
- Accurate/ timely claims adjudication.
- Determines whether to return, deny or pay claims following organizational policies and procedures.
- Performs related duties and special projects as assigned.
- Verified accuracy of submitted claim information by cross-checking with available records.
- Adjudicated claims in line with departmental policies and procedures.
- Provided exceptional customer service by addressing inquiries promptly and professionally.
- Analyzed medical records, bills, and other supporting documents to assess validity of injury claims.
- Verified completeness and accuracy of incoming provider claims.
Education
High School Diploma -
Darlington High School
Darlington, SCSkills
- HCPCS
- CPT
- ICD-9
- Claims procedures
- Researching
- Reading
- Synthesizing information
- SQL
- Database management
- Quality enhancement software
- Analyzing data
- Client relations
Timeline
Quality Assurance Analyst
CareMetx
10.2025 - 03.2026
Claims Processor
NTT Data
05.2025 - Current
Community Associate
Regus/Robert Half
03.2024 - 07.2025
Operations Specialist
Republic Finance
06.2022 - 10.2023
Database Analyst
Amerigas
10.2019 - 03.2022
Reimbursement Counselor/Claims Analyst
Lash Group
05.2015 - 04.2019
Provider File Specialist 1
Blue Cross Blue Shield
05.2013 - 04.2015
Claims Processor 1
Blue Cross Blue Shield
01.2013 - 05.2013
High School Diploma -
Darlington High School